Provider Demographics
NPI:1457940306
Name:MATSUUCHI, M WINSTON
Entity Type:Individual
Prefix:
First Name:M
Middle Name:WINSTON
Last Name:MATSUUCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 RAMSGATE DR APT 118
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6113
Mailing Address - Country:US
Mailing Address - Phone:702-465-3447
Mailing Address - Fax:
Practice Address - Street 1:2201 RAMSGATE DR APT 118
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6113
Practice Address - Country:US
Practice Address - Phone:702-465-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician